Rare Occasion of Congenital Anomalies: Bilateral Syndactyly with Multiple Polydactyly of the Hands and Feet

Main Article Content

Hardianti Putri
Melina Tiza Yanuardani

Abstract

Introduction: Upper and lower limb malformations are essential things that occur related to congenital disabilities, including syndactyly and polydactyly. It may appear in association with other birth defects as a part of a syndrome and may be present in the upper extremity or lower extremity. Cases of bilateral syndactyly with multiple polydactyly of the hands and feet are the first time in our center, and they must be promptly diagnosed and treated to avoid functional and cosmetic problems.


Case presentation: A 3-month-old male toddler presented with webbed index, middle, and ring fingers with synonichia, accompanied by additional fingers on hands and feet. An x-ray examination revealed preaxial polydactyly at both hands with bifid phalanx (Wassel classification) and postaxial polydactyly type B. Duplicated postaxial metatarsal (Venn-Watson classification) and type B postaxial polydactyly also occur on both feet with webbed index and middle toe on the left foot. Direct closure was achieved with a dorsal trapezoidal and zig-zag flap to release the second and third fingers of the right hand, followed by resection of rudimentary fingers to help the child with early stages of motoric functions.


Discussion: Syndactyly can cause a length difference that results in growth and functional difficulties. Surgical release of the index to middle and middle to ring fingers should be done early between 3-6 months of age and is expected to help the child grasp, write, and subsequently manipulate objects. We prioritize operating the right hand as around 90% of people prefer to use the right hand. Simple ligation was also performed to recess the rudimentary fingers on both hands and feet. It has no functional benefit and can limit function as it may get caught or make it difficult to wear shoes and gloves. We have to remind the parents that multiple surgeries may be necessary to achieve a satisfactory result and to complete the reconstruction before 24 months of age when the patterns of function of the digits are established.


Conclusion: Bilateral complex syndactyly with preaxial and postaxial polydactyly on both hands and feet are distinctly uncommon entities that need multidisciplinary treatment. In this instance, the syndactyly releasing of the second and third fingers on the right hand is prioritized based on the function to be achieved, with excision of the rudimentary fingers.

Article Details

How to Cite
Putri, H., & Melina Tiza Yanuardani. (2023). Rare Occasion of Congenital Anomalies: Bilateral Syndactyly with Multiple Polydactyly of the Hands and Feet. International Journal of Medical Science and Clinical Research Studies, 3(11). https://doi.org/10.47191/ijmscrs/v3-i11-67
Section
Articles

References

I. Ahmed H, Akbari H, Emami A, Akbari MR. Genetic overview of syndactyly and polydactyly. Plastic and Reconstructive Surgery - Global Open. 2017;5(11).

II. Xu W, Deng C, Li W, Wang K, Tao J, Gao Y, et al. National perinatal prevalence of selected major birth defects — China, 2010−2018. China CDC Weekly. 2020;2(37):711–7.

III. Upton J. Congenital anomalies of the hand and forearm. In: McCarthy JG, red. Plastic surgery. New York, NY: WB Saunders; 1990;8:5218–398.

IV. Gawlikowska-Sroka A, Tudaj W, Czerwiński F. A and B preaxial polydactyly with syndactyly of feet and hands in the same person — a case report. Advances in Medical Sciences. 2009;54(2).

V. Malik S, Ullah S, Afzal M, Lal K, Haque S. Clinical and descriptive genetic study of polydactyly: A Pakistani experience of 313 cases. Clinical Genetics. 2013;85(5):482–6.

VI. Wassel HD. The Results of Surgery for Polydactyly of the Thumb: A Review. Clinical Orthopaedics and Related Research. 1969 May;64:175–93.

VII. Manske MC, Kennedy CD, Huang JI. Classifications in brief: The Wassel Classification for Radial Polydactyly. Clinical Orthopaedics & Related Research. 2017Jun;475(6):1740–6.

VIII. Temtamy SA, McKusick VA. Polydactyly as a part of syndromes.In:Bergsma D, ed. Mudge JR, Paul NW, Conde Greene S, associate eds. The Genetics of Hand Malformations. New York, NY: Liss. Birth Defects Original Article Series. 1978;14(3):364-439.

IX. Tonkin MA. Failure of differentiation part I: Syndactyly. Hand Clinics. 2009 May;25(2):171–93.

X. Nangineedi N, Harish GP, Rafi M. Management of syndactyly: A clinical study. International Surgery Journal. 2019Jul25;6(8):2806–12.

XI. Jose RM, Timoney N, Vidyadharan R, Lester R. Syndactyly Correction: An aesthetic reconstruction. Journal of Hand Surgery (European Volume). 2010Mar17;35(6):446–50.

XII. Chung KC, Grabb WC, Smith JW. Grabb and Smith's plastic surgery. Philadelphia, PA: Wolters Kluwer; 2020.

XIII. Malik S, Grzeschik K-H. Synpolydactyly: Clinical and molecular advances. Clinical Genetics. 2007Dec19;73(2):113–20.

XIV. Van Wyhe R, Trost J, Koshy J, Pederson W. The duplicated thumb: A Review. Seminars in Plastic Surgery. 2016;30(04):181–8.

XV. Dijkman R, van Nieuwenhoven C, Hovius S, Hülsemann W. Clinical presentation, surgical treatment, and outcome in radial polydactyly. Handchirurgie • Mikrochirurgie • Plastische Chirurgie. 2016Feb19;48(01):10–7.

XVI. Cara Novick MD. Polydactyly of the foot treatment & management [Internet]. Approach Considerations, Surgical Therapy, Postoperative Care. Medscape; 2022 [cited 2022Nov17]. Available from: https://emedicine.medscape.com/article/1260255-treatment

XVII. Peters M, Reimers S, Manning JT. Hand preference for writing and associations with selected demographic and behavioral variables in 255,100 subjects: The BBC internet study. Brain and Cognition. 2006;62(2):177–89.